MEDICARE: MINJI HAILEY KANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	36186	CA

General Provider Information

NPI Number	:	1003645839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINJI HAILEY KANG

Provider Business Mailing Address
First Line	:	10521 VALLEY VIEW ST
Second Line	:
City	:	CYPRESS
State	:	CA
Zip	:	90630-4832
Country	:	US
Telephone Number	:	714-723-2035
Fax Number	:

Provider Business Practice Location Address
First Line	:	10521 VALLEY VIEW ST
Second Line	:
City	:	CYPRESS
State	:	CA
Zip	:	90630-4832
Country	:	US
Telephone Number	:	714-723-2035
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2024
Last Update Date	:	07/30/2024

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Directions to “ MINJI HAILEY KANG ” Practice Location

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